Syaifullah Asmiragani

ANATOMI-MEKANIKA TRAUMA
TULANG BELAKANG
Pendahuluan

 Anatomi Biomekanik

 Anatomi dan Pathomekanik

Biomekanik + MOI

 Pathomekanika Terapi
FONDASI TERPENTING  DIAGNOSIS

SALAH DIAGNOSA  SALAH TERAPI = KTD

YOU KNOW NOTHING

YOU’LL DO NOTHING
PENDAHULUAN
 Functional Spinal
Unit (FSU)
Bagian terkecil tulang
belakang yg
merepresentasikan
karakteristik biomekanik
tulang belakang.

 Terdiri dari : 1 intervertebral

disc, 2 vertebrae, 2 facet,
dan ligaments yg
menghubungkan.

 Kecuali c1-c2
ANATOMI Intervert disc

 Annulus fibrosus 
jaringan fibrous yg
tersusun konsentrik
 Nucleus  gelatinous
material
 End plate
DISKUS

 Nukleus pulposus
berbentuk gel bantal
air yg elastis
meredam gaya aksial
gerak fleksi ekstensi
dan lateral fleksi
Facet
 Sendi Synovial
 Penting dalam
menahan gaya
translasi
 Menahan beban 15 –
20 % berat badan
 Degeneratif  facet
arthrosis
Facet : 8

resist anterior translation, rotation and extention

TULANG

 Biconcave
 Spongious bone
 Cortical bone  pedicle , endplate
TULANG
Tempat
perlekatan

 Ligamen
 Facet
 Discus
Otot
LIGAMEN : Cervical
 Ligaments
 Anterior longitudinal ligament
 Posterior longitudinal ligament
 Ligamentum flavum
 Intertransverse ligaments
 Interspinous ligaments
 Ligamentum nuchae
LIGAMEN : Thoracolumbar
Kolumna Vertebralis

 Memiliki 4 kurva
dengan bentuk lazy S
 Lower Cervical lordosis
 Thoracal kyphosis
 Lumbar lordosis
 Sacro-coccygeal
kyphosis
 Curve balance
Kolumna vertebralis

Functional Spinal Unit

MODE OF INJURY

Mode of Injury A. Axial compresion

B. Fleksion
C. Lateral compresion
D. Shear
E. Extention
F. Flexion distraction
G. Flexion Rotation
The motion present at each level of the
spine.
(Data from multiple reviews and from the experimental work of White, A.; Panjabi, M.
Spine 3:12–20, 1978.)
Kolumna
Vertebralis

 FSU
 Otot
pararavertebral

 Redirection force
Stabilitas thoracolumbar
Zona Transisional
BIOMECHANIC IN SPINAL
TRAUMA
Potential Energy ( fall from height):
(Mass x gravity) x height
FxS
Kinetic energy (RTA) :
1/2 mv2
Temperature (burn) = energy

Trauma is disease of excess of mechanical

energy

Tissue injury (bone and spinal cord) : inability

to absorb transferred energy

thoracic fracture vs thoracolumbar fracture

need more energy  associated injury
more get attention in acute setting
The “physiology” of trauma
 Kerusakanyg ditimbulkan
pada saat menerima
hantaman (energy) pertama
 The 1st HIT  Bisa reversible / irreversible
 Tak ada yg bia dilakukan 
 Kerusakan sudah terjadi
jaringan  Damage control !!!
 Kemampuan diagnostic yg
 respon
pertahanan berstandart tinggi !!!
(inflamasi)

 Berhasil / Gagal

Kematian sel
The “physiology” of trauma
 The 2nd HIT

 Hipoxia dan
hypotensi
 ‘Antigenic’ load
 observasi
 Septic stimuli
 Kemampan
diagnostik yg  Pembedahan
berkualitas !!!
Biomekanik Trauma

 Luas penampang kecil

 gampang cedera
 Mobililitas tinggi
(fleksi-ekstensi-lateral-
rotasi )
 Menyangga berat
kepala
 Gaya > kemampuan
meredam beban =
cedera
Trauma Spinal

 Cedera dapat terjadi pada :

Tulang
Ligamen
Syaraf

 2 hal yg harus diperhatikan:

Instabilitas kolum
Cedera syaraf
Trauma Spinal

Instability :
loss of normal relationship between anatomic
structures with a resulting alteration of
natural function

 Spine can no longer carry normal load

 Permanent deformity may occur resulting in
severe pain
 Potential for cathastrophic neurological injury
Cranio-cervical junction
 Upper Cervical Spine

Lateral atlanto-axial joint

Ant. atlanto-axial joint

C1 dan C2 berbeda dari cervical spine yg lain

dalam bentuk
Upper Cervical Spine

 Menyangga kepala ( 3 x
berat kepala)
 Hampir 50% fleksi 
occiput-C1
 Hampir 50% rotasi 
C1-C2
 Sisanya :
fleksi-ekstensi, rotasi
dan miring lateral
bending  C2-C7
Lower Cervical Spine

 Menyangga kepala ( 3 x
berat kepala)
 Hampir 50% fleksi 
occiput-C1
 Hampir 50% rotasi 
C1-C2
 Sisanya :
fleksi-ekstensi, rotasi
dan miring lateral
bending  C2-C7
Lower C-Spine
Mechanism of injury
6 groups ( Allen-Ferguson)
 Compressive flexion
 Vertical compression
 Distractive flexion
 Compressive extension
 Distractive extension
 Lateral flexion
Allen-Fergusson Classification
Compressive Flexion Injury
Allen-Fergusson Classification
Vertical Compression Injury
Allen-Fergusson Classification
Distractive Flexion Injury
THORACOLUMBAR
BIOMEKANIKA TRAUMA
Three Column Theory ( Denis ,1984 )

The anterior column

The middle column
The posterior column
INSTABILITY OF THORACIC & LUMBAR SPINE
ANTERIOR - POSTERIOR FAILURE
INSTABILITY OF THORACIC & LUMBAR SPINE
POSTERIOR (COMPLEX) FAILURE
TYPE OF THORACOLUMBAR
FRACTURE
1.Compression
Fracture

Involved of anterior
column of the vertebral
body
ANTERIOR COLLUMN FAILURE  Compression frature
2.Burst Fracture

• Result of an axial
compressive force
• Involved anterior and
middle column ( the
posterior wall cortex).
• Some degree of
fragment retropulsion
will produce spinal
canal stenosis
(narrowing of spinal
canal).
Burst Fracture

• Result of an axial
compressive force
• Involved anterior and
middle column ( the
posterior wall cortex).
• Some degree of
fragment retropulsion
will produce spinal
canal stenosis
(narrowing of spinal
canal).
ANTERIOR - MIDDLE COLLUMN FAILURE  Burst Fracture
3. Flexion-Distraction (Seat Belt or Chance
Type) Injuries
Tensile failure of the PLC, facet
capsules, and intervertebral disc
or bone itself ( posterior and
middle columns injury).

Injuries may occur through bone

alone, soft tissue alone or
combined.

Combined lesion are the most

common lesion .
4. Fracture-Dislocations

• Highly unstable injuries

• All three column are
involved
• Translational deformity
Magerl, Gertzbein et al Classification

Type A
Magerl, Gertzbein et al Classification

Type B
Magerl, Gertzbein et al Classification

Type C
Treatment

 Non operative
 Operative
THORACOLUMBAR SPINE INJURY

Non Operative stable type

 Postural Reduction & Body Spica Cast

 Bracing (Jewett, Taylor, Hyperextention
brace, TLSO)
Tujuan operasi  umum dan khusus

Khusus :
1. KOREKSI PENJAJARAN (ALIGNMENT)
( utk mengembalikan Coronal & Sagittal
Balance)
2. PERLINDUNGAN STRUKTUR SYARAF
3. MENCEGAH DEFORMITAS LANJUT
Indikasi Operasi
(untuk tujuan 1 dan 3)

 Fraktur Dislokasi
 Fraktur Kompresi :
- Sudut Cobb : > 30 derajat
- Loss of Body Height > 50%
 Fraktur Burst :
- Sudut Cobb : > 30 derajat
- Loss of Body Height > 50%
- Canal encroachment > 40%
- Translasi AP > 3,5 mm
 Fraktur seat belt